Surgical accessory clamp and system

ABSTRACT

A robotic surgical system for performing a procedure within a sterile field comprises a manipulator arm and a surgical accessory clamp for coupling a surgical accessory to a distal end portion of the manipulator arm. The accessory clamp includes a base for coupling with the distal end portion of the manipulator arm, two clamp jaws with each of the clamp jaws directly and rotatably coupled to the base by respective pivot pins, and a lever operable to move the two clamp jaws between an open position and closed position. The system also includes a sterile drape covering the accessory clamp and the manipulator arm to shield the accessory clamp and the manipulator arm from the sterile field.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.11/240,087, filed Sep. 30, 2005, now U.S. Pat. No. 8,182,469, which is acontinuation-in-part of U.S. patent application Ser. No. 10/922,346,filed Aug. 19, 2004, now U.S. Pat. No. 7,357,774, which is acontinuation of U.S. patent application Ser. No. 10/004,399, filed Oct.30, 2001, now abandoned, which is a continuation of U.S. patentapplication Ser. No. 09/406,360, filed Sep. 28, 1999, now U.S. Pat. No.6,346,072, which is a continuation of U.S. patent application Ser. No.08/975,617, filed Nov. 21, 1997, now U.S. Pat. No. 6,132,368, the fulldisclosures of which are hereby incorporated by reference for allpurposes.

TECHNICAL FIELD

The present invention relates generally to surgical robot systems and,more particularly, to accessory clamps for robotic arms.

BACKGROUND

In robotically-assisted or telerobotic surgery, the surgeon typicallyoperates a master controller to remotely control the motion of surgicalinstruments at the surgical site from a location that may be remote fromthe patient (e.g., across the operating room, in a different room or acompletely different building from the patient). The master controllerusually includes one or more hand input devices, such as joysticks,exoskeletal gloves or the like, which are coupled to the surgicalinstruments with servo motors for articulating the instruments at thesurgical site. The servo motors are typically part of anelectromechanical device or surgical manipulator (“the slave”) thatsupports and controls the surgical instruments that have been introduceddirectly into an open surgical site or through trocar sleeves into abody cavity, such as the patient's abdomen. During the operation, thesurgical manipulator provides mechanical articulation and control of avariety of surgical instruments, such as tissue graspers, needledrivers, electrosurgical cautery probes, etc., that each perform variousfunctions for the surgeon, e.g., holding or driving a needle, grasping ablood vessel, or dissecting, cauterizing or coagulating tissue.

This new method of performing telerobotic surgery through remotemanipulation has, of course, created many new challenges. One suchchallenge results from the fact that a portion of the electromechanicalsurgical manipulator will be in direct contact with the surgicalinstruments, and will also be positioned adjacent the operation site.Accordingly, the surgical manipulator may become contaminated duringsurgery and is typically disposed of or sterilized between operations.From a cost perspective, it would be preferable to sterilize the device.However, the servo motors, sensors, encoders, and electrical connectionsthat are necessary to robotically control the motors typically cannot besterilized using conventional methods, e.g., steam, heat and pressure,or chemicals, because the system parts would be damaged or destroyed inthe sterilization process.

Yet another challenge with telerobotic surgery systems is that a surgeonwill typically employ a large number of different surgical instrumentsduring a procedure. Since the number of instrument holders are limiteddue to space constraints and cost, many of these surgical instrumentswill be attached and detached from the same instrument holder a numberof times during an operation. In laparoscopic procedures, for example,the number of entry ports into the patient's abdomen is generallylimited during the operation because of space constraints as well as adesire to avoid unnecessary incisions in the patient. Thus, a number ofdifferent surgical instruments will typically be introduced through thesame trocar sleeve during the operation. Likewise, in open surgery,there is typically not enough room around the surgical site to positionmore than one or two surgical manipulators, and so the surgeon'sassistant will be compelled to frequently remove instruments from theholder and exchange them with other surgical tools. However in the past,instrument holders have been difficult or cumbersome to use, requiringthe use of both hands. Furthermore, past instrument holders have beenrequired to be detached and sterilized after each procedure.

What is needed, therefore, are improved telerobotic systems and methodsfor remotely controlling surgical instruments at a surgical site on apatient. These systems and methods should be configured to minimize theneed for sterilization to improve cost efficiency. In addition, thesesystems and methods should be designed to minimize instrument exchangetime and difficulty during the surgical procedure. Accordingly, anaccessory clamp and system for robotic surgery having improvedefficiency and cost-effectiveness is highly desirable.

SUMMARY

The present invention provides an advantageous system, apparatus, andmethod for clamping of surgical accessories used for teleroboticsurgery.

In accordance with an embodiment of the present invention, a surgicalaccessory clamp of a robotic surgical system is provided, the accessoryclamp including a base for coupling to a distal end of a manipulatorarm, and two clamp jaws for receiving a surgical accessory, the twoclamp jaws operably coupled to the base. The clamp further includes asterile drape portion over the two clamp jaws, and a lever portioncapable of actuating the two clamp jaws into an open position or aclosed position.

In accordance with another embodiment of the present invention, asurgical accessory clamp of a robotic surgical system is provided, theaccessory clamp including a base for coupling to a distal end of amanipulator arm, the base including a first mounting portion; a steriledrape portion over the first mounting portion; and a second mountingportion for clamping or releasing a surgical accessory between the firstand second mounting portions.

In accordance with yet another embodiment of the present invention, arobotic surgical system for performing a procedure within a sterilefield is provided, the system including a manipulator arm, a surgicalaccessory clamp for coupling a surgical accessory to a distal endportion of the manipulator arm, and a sterile drape covering theaccessory clamp and the manipulator arm to shield the accessory clampand the manipulator arm from the sterile field.

In accordance with yet another embodiment of the present invention, arobotic surgical system for performing a procedure within a sterilefield is provided, the system including a surgical tool; a manipulatorassembly including a manipulator arm having proximal and distal endportions; a cannula defining an inner lumen for receiving the surgicaltool and providing access through a percutaneous penetration in thepatient; a cannula adaptor for coupling the cannula to the distal endportion of the manipulator arm; and a sterile drape covering the cannulaadaptor and the manipulator arm to shield the cannula adaptor and themanipulator arm from the sterile field.

In accordance with yet another embodiment of the present invention, amethod of clamping a surgical accessory in a robotic surgical system isprovided, the method including providing a surgical accessory clamp asdescribed above, positioning a sterile drape over the two clamp jaws,actuating the accessory clamp into the open position, providing thesurgical accessory between the two clamp jaws, and actuating theaccessory clamp into the closed position.

In accordance with yet another embodiment of the present invention, amethod of clamping a surgical accessory in a robotic surgical system isprovided, the method including attaching a surgical accessory clamp to adistal end portion of a manipulator arm, covering the manipulator armand accessory clamp with a sterile drape to shield the manipulator armand accessory clamp from a sterile field, and attaching an accessory tothe accessory clamp within the sterile field.

Advantageously, the present invention provides an enhanced clampingapparatus and method for robotic surgical systems that does not requirere-sterilization and allows for easy exchange of instruments, tools, oraccessories, thereby improving cost-effectiveness and efficiency.

The scope of the invention is defined by the claims, which areincorporated into this section by reference. A more completeunderstanding of embodiments of the present invention will be affordedto those skilled in the art, as well as a realization of additionaladvantages thereof, by a consideration of the following detaileddescription of one or more embodiments. Reference will be made to theappended sheets of drawings that will first be described briefly.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic view of an operating room, illustrating atelerobotic surgical system and method in accordance with an embodimentof the present invention.

FIG. 2 is an enlarged view of the operating room of FIG. 1 illustratinga pair of mounting joints coupled to an operating table according to thepresent invention.

FIG. 3A is a perspective view of a robotic surgical manipulator that ispartially covered by a sterile drape in accordance with an embodiment ofthe present invention.

FIG. 3B is a perspective view of the robotic surgical manipulator ofFIG. 3A without the sterile drape to illustrate a multiple degree offreedom arm coupling a driving assembly with a wrist unit and a surgicaltool.

FIG. 4 illustrates the robotic surgical manipulator of FIGS. 3A-3Bincorporating a camera and endoscope for viewing the surgical site.

FIG. 5 is a partial view of the robotic manipulator of FIGS. 3A-3B,illustrating mechanical and electrical couplings between the arm and thewrist unit.

FIG. 6 is a partially cut-away sectional view of a forearm and acarriage of the manipulator of FIGS. 3A and 3B.

FIG. 7 is a perspective view of the wrist unit in accordance with anembodiment of the present invention.

FIG. 8 is a side cross-sectional view of a portion of the roboticmanipulator, illustrating the arm and the drive assembly.

FIG. 9A is a perspective view of a robotic surgical manipulator that ispartially covered by a sterile drape in accordance with anotherembodiment of the present invention.

FIGS. 9B-9C are views of the robotic surgical manipulator of FIG. 9Awithout the sterile drape to illustrate a multiple degree of freedom armcoupling a driving assembly with a surgical accessory clamp, a wristunit, and a surgical tool.

FIG. 10 is a cross-section view of the surgical accessory clamp,surgical accessory, and sterile drape portion therebetween, inaccordance with an embodiment of the present invention.

FIGS. 11A-11C illustrate a cannula as a surgical accessory and across-section of a sensing mechanism for the accessory in accordancewith an embodiment of the present invention.

FIGS. 12A-12C illustrate different views of a surgical accessory clampin accordance with an embodiment of the present invention.

FIGS. 13A-13B illustrate perspective views of a surgical accessoryretained in the surgical accessory clamp of FIGS. 12A-12C in accordancewith an embodiment of the present invention.

FIGS. 14A-14C illustrate perspective and side views for positioning andclamping a surgical accessory in the surgical accessory clamp of FIGS.12A-12C in accordance with an embodiment of the present invention.

FIGS. 15 and 16 illustrate two sterile drape portions that may fit overclamp jaws of the accessory clamp.

FIGS. 17A-17E illustrate perspective views for positioning a steriledrape portion over the clamp jaws of the accessory clamp and thenclamping the accessory between the clamp jaws.

FIGS. 18A-18C illustrate views of a slide accessory clamp in accordancewith another embodiment of the present invention.

FIGS. 19A and 19B illustrate a pivot accessory clamp in accordance withanother embodiment of the present invention.

FIG. 20 illustrates another pivot accessory clamp in accordance withanother embodiment of the present invention.

FIGS. 21A-21B illustrate another pivot accessory clamp in accordancewith another embodiment of the present invention.

FIGS. 22A-22C illustrate perspective views for positioning and clampinga surgical accessory in the surgical accessory clamp of FIGS. 21A-21B inaccordance with an embodiment of the present invention.

FIGS. 23A-23C illustrate another pivot accessory clamp in accordancewith another embodiment of the present invention.

FIGS. 24A-24F illustrate perspective views for positioning and clampinga surgical accessory in a surgical accessory clamp in accordance withanother embodiment of the present invention.

FIGS. 25A-25B illustrate perspective views of a first mounting portionin accordance with an embodiment of the present invention.

FIGS. 26A-26B illustrate perspective views of a second mounting portionin accordance with an embodiment of the present invention.

Embodiments of the present invention and their advantages are bestunderstood by referring to the detailed description that follows. Itshould be appreciated that like reference numerals are used to identifylike elements illustrated in one or more of the figures. It should alsobe appreciated that the figures may not be necessarily drawn to scale.

DETAILED DESCRIPTION

The present invention provides a multi-component system and method forperforming robotically-assisted surgical procedures on a patient,particularly including open surgical procedures, neurosurgicalprocedures, such as stereotaxy, and endoscopic procedures, such aslaparoscopy, arthroscopy, thoracoscopy and the like. The system andmethod of the present invention is particularly useful as part of atelerobotic surgical system that allows the surgeon to manipulate thesurgical instruments through a servomechanism from a remote locationfrom the patient. To that end, the manipulator apparatus or slave of thepresent invention will usually be driven by a kinematically-equivalentmaster to form a telepresence system with force reflection. Adescription of a suitable slave-master system can be found in U.S.patent application Ser. No. 08/517,053, filed Aug. 21, 1995, thecomplete disclosure of which is incorporated herein by reference for allpurposes.

Referring to the drawings in detail, wherein like numerals indicate likeelements, a telerobotic surgical system 2 is illustrated according to anembodiment of the present invention. As shown in FIG. 1, teleroboticsystem 2 generally includes one or more surgical manipulator assemblies4 mounted to or near an operating table O, and a control assembly 6 forallowing the surgeon S to view the surgical site and to control themanipulator assemblies 4. The system 2 will also include one or moreviewing scope assemblies 19 and a plurality of surgical instrumentassemblies 20 adapted for being removably coupled to manipulatorassemblies 4 (discussed in detail below). Telerobotic system 2 usuallyincludes at least two manipulator assemblies 4 and preferably threemanipulator assemblies 4. The exact number of manipulator assemblies 4will depend on the surgical procedure and the space constraints withinthe operating room among other factors. As discussed in detail below,one of the assemblies 4 will typically operate a viewing scope assembly19 (e.g., in endoscopic procedures) for viewing the surgical site, whilethe other manipulator assemblies 4 operate surgical instruments 20 forperforming various procedures on the patient P.

Control assembly 6 may be located at a surgeon's console C which isusually located in the same room as operating table O so that thesurgeon may speak to his/her assistant(s) A and directly monitor theoperating procedure. However, it should be understood that the surgeon Scan be located in a different room or a completely different buildingfrom the patient P. Control assembly 6 generally includes a support 8, amonitor 10 for displaying an image of the surgical site to the surgeonS, and one or more controller(s) 12 for controlling manipulatorassemblies 4. Controller(s) 12 may include a variety of input devices,such as joysticks, gloves, trigger-guns, hand-operated controllers,voice recognition devices or the like. Preferably, controller(s) 12 willbe provided with the same degrees of freedom as the associated surgicalinstrument assemblies 20 to provide the surgeon with telepresence, orthe perception that the controller(s) 12 are integral with theinstruments 20 so that the surgeon has a strong sense of directlycontrolling instruments 20. Position, force, and tactile feedbacksensors (not shown) may also be employed on instrument assemblies 20 totransmit position, force, and tactile sensations from the surgicalinstrument back to the surgeon's hands as he/she operates thetelerobotic system. One suitable system and method for providingtelepresence to the operator is described in U.S. patent applicationSer. No. 08/517,053, filed Aug. 21, 1995, which has previously beenincorporated herein by reference.

Monitor 10 will be suitably coupled to the viewing scope assembly 19such that an image of the surgical site is provided adjacent thesurgeon's hands on surgeon console C. Preferably, monitor 10 willdisplay an inverted image on a display 18 that is oriented so that thesurgeon feels that he or she is actually looking directly down onto theoperating site. To that end, an image of the surgical instruments 20appears to be located substantially where the operator's hands arelocated even though the observation points (i.e., the endoscope orviewing camera) may not be from the point of view of the image. Inaddition, the real-time image is preferably transformed into aperspective image such that the operator can manipulate the end effectorand the hand control as if viewing the workspace in substantially truepresence. By true presence, it is meant that the presentation of animage is a true perspective image simulating the viewpoint of anoperator that is physically manipulating the surgical instruments 20.Thus, a controller (not shown) transforms the coordinates of thesurgical instruments 20 to a perceived position so that the perspectiveimage is the image that one would see if the camera or endoscope waslocated directly behind the surgical instruments 20. A suitablecoordinate transformation system for providing this virtual image isdescribed in U.S. patent application Ser. No. 08/239,086, filed May 5,1994, now U.S. Pat. No. 5,631,973, the complete disclosure of which isincorporated herein by reference for all purposes.

As shown in FIG. 1, a servomechanism 16 is provided for transferring themechanical motion of controllers 12 to manipulator assemblies 4.Servomechanism 16 may be separate from, or integral with manipulatorassemblies 4. Servomechanism 16 will usually provide force and torquefeedback from the surgical instruments 20 to the hand-operatedcontrollers 12. In addition, servomechanism 16 will include a safetymonitoring controller (not shown) that may freeze or at least inhibitall robot motion in response to recognized conditions (e.g., exertion ofexcessive force on the patient, “running away” of the manipulatorassemblies 4, etc.). The servomechanism preferably has a servo bandwidthwith a 3 dB cut off frequency of at least 10 hz so that the system canquickly and accurately respond to the rapid hand motions used by thesurgeon. To operate effectively with this system, manipulator assemblies4 have a relatively low inertia and the drive motors 170 (see FIG. 8)have relatively low ratio gear or pulley couplings. Any suitableconventional or specialized servomechanism may be used in the practiceof the present invention, with those incorporating force and torquefeedback being particularly preferred for telepresence operation of thesystem.

Referring to FIG. 7, surgical instrument assemblies 20 each include awrist unit 22 and a surgical tool 24 (FIGS. 3A and 3B) removablyattached to wrist unit 22. As discussed in detail below, each wrist unit22 generally includes an elongate shaft 56 having a proximal cap 58 anda distal wrist 60 pivotally coupled to surgical tool 24. Each wrist unit22 is substantially the same, and will have different or the samesurgical tools 24 attached thereto, depending on the requirements of thesurgical procedure. Alternatively, wrist units 22 may have specializedwrists 60 designed for individual surgical tools 24 so that the wristunits 22 may be used with conventional tools 24. As shown in FIG. 1, theinstrument assemblies 20 are usually assembled onto a table T or othersuitable support adjacent the operating table O. According to a methodof the present invention (described below), wrist units 22 and theirassociated surgical tools 24 can be quickly exchanged during thesurgical procedure by coupling and decoupling wrist unit shafts 56 frommanipulator assemblies 4.

Referring to FIG. 2, each manipulator assembly 4 is preferably mountedto operating table O by a mounting joint 30. Mounting joints 30 providea number of degrees of freedom (preferably at least 5) to assemblies 4,and they include a brake (not shown) so that assemblies 4 can be fixedat a suitable position and orientation relative to the patient. Joints30 are mounted to a receptacle 32 for mounting joints 30 to operatingtable O, and for connecting each manipulator assembly 4 toservomechanism 16. In addition, receptacle 32 may connect joints 30 toother systems, such as an RF electrical power source, asuction-irrigation system, etc. Receptacle 32 includes a mounting arm 34that is slidably disposed along an outer rail 36 of operating table O.Manipulator assemblies 4 may also be positioned over the operating tableO with other mechanisms. For example, the system may incorporate asupport system (coupled to the ceiling or a wall of the operating room)that moves and holds one or more manipulator assemblies 4 over thepatient.

Referring now to FIGS. 3-8, manipulator assembly 4 will be described infurther detail. Manipulator assembly 4 is a three-component apparatusthat includes a non-sterile drive and control component, a sterilizableend effector or surgical tool (i.e., surgical instrument assembly 20),and an intermediate connector component. The intermediate connectorincludes mechanical elements for coupling the surgical tool 24 with thedrive and control component, and for transferring motion from the drivecomponent to the surgical tool 24. As shown in FIG. 3B, the drive andcontrol component generally includes a drive assembly 40 and a multipledegree of freedom robotic arm 42 coupled to a mounting bracket 44, whichis adapted for mounting onto mounting joints 30 (FIG. 2). Preferably,drive assembly 40 and robotic arm 42 are pivotally coupled to bracket 44about an X-axis, which extends through a remote center of sphericalrotation 45 (see FIG. 8, discussed in further detail below). Manipulatorassembly 4 further includes a forearm assembly 46 fixed to a distal end48 of arm 42, and a wrist unit adaptor 52 coupled to forearm assembly 46for mounting wrist unit 22 and surgical tool 24 to manipulator assembly4.

For endoscopic procedures, manipulator assembly 4 additionally includesa cannula adaptor 64 attached to a lower portion of forearm 46 formounting a cannula 66 to manipulator assembly 4. Alternatively, cannula66 may be an integral cannula (not shown) that is built into forearmassembly 46 (i.e., non-removable). Cannula 66 may include a forcesensing element (not shown), such as a strain gauge or force-sensingresistor, mounted to an annular bearing within cannula 66. The forcesensing bearing supports surgical tool 24 during surgery, allowing thetool to rotate and move axially through the central bore of the bearing.In addition, the bearing transmits lateral forces exerted by thesurgical tool 24 to the force sensing element, which is connected toservomechanism 16 for transmitting these forces to controller(s) 12. Inthis manner, forces acting on surgical tools 24 can be detected withoutdisturbances from forces acting on cannula 66, such as the tissuesurrounding the surgical incision, or by gravity and inertial forcesacting on manipulator assembly 4. This facilitates the use ofmanipulator assembly 4 in a robotic system because the surgeon willdirectly sense the forces acting against the surgical tool 24.

As shown in FIG. 3A, manipulator assembly 4 further includes a steriledrape 70 sized to cover substantially the entire manipulator assembly 4.Drape 70 has a pair of holes 72, 74 sized and arranged so that wristunit adaptor 52 and cannula adaptor 64 may extend through holes 72, 74to mount wrist unit 22 and cannula 66 to manipulator assembly 4. Steriledrape 70 comprises a material configured to effectively shieldmanipulator assembly 4 from the surgical site so that most of thecomponents of assembly 4 (i.e., arm 42, drive assembly 40 and forearmassembly 46) do not have to be sterilized prior to, or following thesurgical procedure.

As shown in FIG. 3A, wrist unit adaptor 52 and cannula adaptor 64 extendthrough holes 72, 74 of drape 70 so that forearm assembly 46 and theremainder of manipulator assembly 4 remain shielded from the patientduring the procedure. In one embodiment, wrist unit adaptor 52 andcannula adaptor 64 are manufactured as reusable components that will besterilized because these components extend into the sterile field of thesurgical site. Wrist unit and cannula adapters 52, 64 may be sterilizedby normal methods, i.e., steam, heat and pressure, chemicals and thelike. Referring again to FIG. 3B, wrist unit adaptor 52 includes anopening 80 for receiving shaft 56 of wrist unit 22. As discussed indetail below, shaft 56 can be laterally urged through opening 80 andsnap-fit into adaptor 52 such that the non-exposed portion of wrist unitadaptor 52 remains sterile (i.e., remains on the sterile side of drape70 opposite the sterile field). Wrist unit adaptor 52 may also include alatch (not shown) for securing wrist unit 22 therein. Similarly, cannulaadaptor 64 includes an opening 82 for snap fitting cannula 66 theretosuch that the non-exposed portion of adaptor 64 remains sterile duringthe surgical procedure.

As shown in FIG. 4, wrist unit adaptor 52 may also be configured toreceive a viewing scope 100 for viewing the surgical site. Forendoscopic procedures, viewing scope 100 can be a conventionalendoscope, which typically includes a rigid, elongated tube 102containing a lens system (not shown) and a camera mount 104 at theproximal end of the tube 102. A small video camera 106 is preferablyattached to the camera mount 104 and connected to video monitor 10 toprovide a video image of the procedure. Preferably, the scope 100 has adistal end (not shown) configured to allow lateral or angled viewingrelative to tube 102. The viewing scope may also have a guidable tipthat can be deflected or rotated by manipulating an actuator on aproximal end of tube 102. This type of scope is commercially availablefrom Baxter Healthcare Corp. of Deerfield, Ill., or Origin Medsystems,Inc. of Menlo Park, Calif.

As shown in FIG. 4, viewing scope 100 further includes a scope adaptor110 for coupling viewing scope 100 to wrist unit adaptor 52. Scopeadaptor 110 is sterilizable, ETO and autoclavable, and it includes aplurality of motion feed-throughs (not shown) for transferring motionfrom drive assembly 40 to scope 100. In the preferred configuration, themotion includes pitch and yaw motion, rotation about the Z-axis, andmovement along the Z-axis.

Referring now to FIGS. 5 and 6, forearm assembly 46 will be described infurther detail. As shown in FIG. 5, forearm assembly 46 includes ahousing 120 fixed to arm 42 and a movable carriage 122 slidably coupledto housing 120. Carriage 122 slidably mounts wrist unit adaptor 52 tohousing 120 for moving wrist unit adaptor 52 and wrist unit 20 in theZ-direction. In addition, carriage 122 defines a number of openings 123for transferring motion and electrical signals from forearm assembly 46to wrist unit adaptor 52. As shown in FIG. 6, a plurality of rotatableshafts 124 are mounted within housing 120 for transferring motion fromarm 42 through openings 123 to wrist unit adaptor 52 and wrist unit 22.Rotating shafts 124 preferably provide at least four degrees of freedomto wrist unit 22, including yaw and pitch motion of surgical tool 24about wrist 60 of wrist unit 22, rotation of wrist unit 22 about theZ-axis and actuation of tool 24. The system may also be configured toprovide more or less degrees of freedom, if desired. Actuation of tool24 may include a variety of motions, such as opening and closing jaws,graspers or scissors, applying clips or staples and the like. Motion ofwrist unit 22 and tool 24 in the Z direction is provided by a pair ofcarriage cable drives 126 extending between rotatable pulleys 128, 129on either end of forearm housing 120. Cable drives 126 function to movecarriage 122 and wrist unit 22 in the Z direction relative to forearmhousing 120.

As shown in FIG. 6, distal end 48 of arm 42 includes a coupling assembly130 having a plurality of motion feed-throughs 132 for transferringmotion from arm 42 to forearm assembly 46. In addition, couplingassembly 130 includes a number of electrical connectors (not shown) fortransferring electrical signals from arm 42 to wrist unit 22. Similarly,wrist unit adaptor 52 includes a plurality of motion feed-throughs (notshown) and electrical connections (not shown) for transferring motion,and for sending and receiving electrical signals to and from wrist unit22 (e.g., for sending and receiving force and torque feedback signalsfrom the surgical site to controllers 12). The components on either sideof coupling assembly 130 and wrist unit adaptor 52 have a finite rangeof motion. Usually, this range of motion will be at least 1 revolutionand preferably greater than 1 revolution. These ranges of motion arealigned with each other when the forearm assembly 46 is mechanicallycoupled to the coupling assembly 130 and when wrist unit adaptor 52 ismechanically coupled to the forearm 46.

Referring to FIG. 7, wrist unit 22 will now be described in furtherdetail. As shown, wrist unit 22 includes a hollow shaft 56 having a cap58 attached to its proximal end and a wrist 60 attached to its distalend. Wrist 60 includes a coupling (not shown) for removably coupling avariety of surgical tools 24 to shaft 56. Shaft 56 is rotatably coupledto cap 58 for providing rotation of shaft 56 and tool 24 about thelongitudinal axis of shaft 56 (i.e., the Z axis). Cap 58 houses amechanism (not shown) for transferring motion from wrist unit adaptor 52to drive cables (not shown) within shaft 56. The drive cables aresuitably coupled to drive pulleys within shaft 56 to pivot tool 24 aboutwrist 60, and to actuate end effectors 140 on tool 24. Wrist 60 may alsobe operated by other mechanisms, such as differential gears, push-rods,or the like.

Tool 24 is removably coupled to wrist 60 of wrist unit 22. Tool 24 willpreferably include an end effector 65 (FIGS. 3A and 3B) having a tactilesensor array (not shown) for providing tactile feedback to the surgeon.Tool 24 may include a variety of articulated tools, such as jaws,scissors, graspers, needle holders, micro dissectors, staple appliers,tackers, suction irrigation tools, clip appliers, that have endeffectors driven by wire links, eccentric cams, push-rods or othermechanisms. In addition, tool 24 may comprise a non-articulatedinstrument, such as cutting blades, probes, irrigators, catheters orsuction orifices. Alternatively, tool 24 may comprise an electrosurgicalprobe for ablating, resecting, cutting or coagulating tissue. In thelatter embodiment, wrist unit 22 will include a conductive element, suchas a proximal banana plug coupled to a lead wire or rod extendingthrough shaft 56 to tool 24.

Referring to FIGS. 4 and 8, a specific configuration of the drive andcontrol component of the present invention (i.e., the robotic arm 42 anddrive assembly 40) will be described in further detail. As discussedabove, arm 42 and drive assembly 40 are rotatably coupled about a pairof pins 150 extending from mounting bracket 44. Arm 42 preferablycomprises an elongate, substantially rigid body 152 with a distal end 48coupled to forearm assembly 48 and a proximal end 154 pivotally coupledto drive assembly 40 and bracket 44 for rotation about pitch and yaw orthe X and Y axes (note that the Y axis is perpendicular to the page andextends through point 45, see FIG. 8). Arm 40 may have otherconfigurations, such as an elbow arm (similar to the human arm),prismatic arm (straight extendable) or the like. A stationary yaw motor156 is mounted to mounting bracket 44 for rotating arm 42 and driveassembly 40 about the X-axis. Drive assembly 40 also includes a pitchmotor 158 coupled to arm 42 for rotating arm about the Y axis. A pair ofsubstantially rigid linkage elements 160, 124 extend from bracket 44 torobotic arm 42 to pivotally couple arm 42 to bracket 44 about Y-axis.One of the linkage elements 160 is pivotally coupled to arm 42, and theother linkage element 124 is pivotally coupled to a third linkageelement 164 extending parallel to arm 42. Preferably, robotic arm 42 isa channel shaped rigid element that at least partially houses the thirdlinkage element 164. The linkage elements 160, 124 and 164 and arm 42form a parallelogram linkage in which the members are connected togetherin a parallelogram for relative movement only in the plane formed by themembers.

The Z-axis of wrist unit 22 held at the distal end 48 of arm 42intersects the x axis of the parallelogram linkage described above.Wrist unit 22 has a remote center of spherical rotation about theposition indicated by the numeral 45 in FIG. 8. Thus, the distal end ofwrist unit 22 can be rotated about its own axis or the X and Y axeswhile the remote center of rotation 45 remains at the same location. Amore complete description of a remote center positioning device can befound in U.S. patent application Ser. No. 08/504,301, filed Jul. 20,1995, now U.S. Pat. No. 5,931,832, the complete disclosure of which isincorporated herein by reference for all purposes. It should be notedthat arm 42 and drive assembly 40 may be used with a broad range ofpositioning devices other than that described above and shown in FIG. 8,such as a stereotaxic positioner, a fixed gimbal, or the like.

Referring again to FIG. 8, drive assembly 40 further includes aplurality of drive motors 170 coupled to arm 42 for rotation therewith.Pitch and yaw motors 156, 158 control the motion of arm 42 (and drivemotors 170) about the X and Y axes and drive motors 170 control themotion of wrist unit 22 and surgical tool 24. Preferably, at least fivedrive motors 170 are coupled to arm 42 for providing at least fivedegrees of freedom to wrist unit 22. Drive motors 170 will preferablyinclude encoders (not shown) for responding to servomechanism 16 andforce sensors (not shown) for transmitting force and torque feedback tothe surgeon S. As discussed above, the five degrees of freedompreferably include movement of carriage 122 and wrist unit 22 in theZ-direction, rotation of wrist unit 22 about the Z-axis, pitch and yawrotation of surgical tool 24 around wrist 60 and actuation of tool 24.

As shown, cables 172 extend from each motor 170 around a motor drivepulley 174, an idler pulley 176 within arm 42 and along a relativelylarge pot capstan 178 to minimize the effect of friction torque oncables 172. The cables 172 each extend around another idler pulley 180at distal end 48 of arm 42, around a coupling drive pulley 182 and backto the motor 170. The cables 172 will preferably be tensioned at themotor drive pulley 174 and anchored there as well as at the couplingdrive pulley 182. As shown in FIG. 8, coupling drive pulley 182 isconnected to a plurality of smaller pulleys 184 within coupling assembly130 via a plurality of cables 186 for transferring motion from themotors 170 to wrist unit adaptor 52.

A method for performing a surgical procedure on a patient according tothe present invention will now be described with reference to FIGS. 1-9.As shown in FIG. 2, mounting joints 30 are attached to receptacle 32,which is attached to the operating table O by sliding mounting arm 34along rail 36. Each manipulator assembly 4 is then attached to itsrespective mounting joint 30 and articulated into the proper positionand orientation relative to the patient P. Receptacles 32 are thencoupled to, servomechanism 16 and other systems that may be requiredduring the surgical procedure, such as an RF power supply, asuction/irrigation system, etc. Sterile drapes 70 are placed over themanipulator assemblies 4 before, during, or after the patient has beenanesthetized (FIG. 3A). To prepare for the surgical procedure,manipulator assemblies 4 may or may not be chemically cleaned prior tocovering them with drapes 70. Wrist unit adapters 52, cannula adapters64, and scope adapters 110 are snapped onto forearm assemblies 46 ofmanipulator assemblies 4 (see FIGS. 3B and 5). The number and relativepositions of scope adapters 110 and wrist unit adapters 52 will, ofcourse, depend on the individual surgical procedure (e.g., cannulaadapters 64 may not be required for open surgical procedures).

During the surgical procedure, surgical instrument assemblies 20 arecoupled to their respective manipulator assemblies 4 by laterally urgingeach respective wrist unit shaft 56 through opening 80 of wrist unitadaptor 52. Each wrist unit 22 will have suitable identification means(not shown) to quickly and easily indicate what type of tool 24 isconnected to the wrist unit 22. When the surgeon wishes to changesurgical tools 24, he or she manipulates controller(s) 12 so thatcarriage 122 moves to a top or proximal position of travel along forearmassembly 46 (see FIG. 3B). In this position, surgical tool 24 is withincannula 66 or during open procedures, removed from the surgical site.The assistant(s) A then pulls upward on wrist cap 58 to release thelatch (not shown), thereby allowing wrist unit 22 to slide furtherupwards and out of cannula 66. The assistant(s) A may then pull wristunit 22 laterally to decouple it from wrist unit adaptor 52. When wristunit 22 is no longer coupled to adaptor 52, the control mechanismunderstands that the system is in “tool change mode”, and drivescarriage 122 to the proximal position if it has not already been movedthere by the surgeon.

To couple another surgical instrument assembly 20 to manipulatorassembly 4, the assistant(s) A grabs another assembly 20 from table T,laterally urges wrist unit shaft 56 into opening 80 of wrist unitadaptor 52, and then moves wrist unit 22 downward so that surgical tool24 resides within cannula 66 (see FIGS. 1 and 3B). This downwardmovement of wrist unit 22 automatically mates the electrical couplingsand motion feed-throughs (not shown) within wrist cap 58 and wrist unitadaptor 52. The system may include a control mechanism configured tolock carriage 122 travel at the top or proximal position, e.g., byactuating a brake (not shown), until the couplings are mated and wristunit 22 is no longer being moved downward. At this point, the surgeon Smay continue the surgical procedure.

The system and method of the present invention preferably includes amechanism for counting the number of times wrist unit 22 is decoupledand coupled from wrist unit adaptor 52. In this manner, the manufacturermay limit the number of times wrist unit 22 can be used. In a specificconfiguration, an integrated circuit chip (not shown) is housed withinwrist cap 58. The circuit chip counts the number of times wrist unit 22is coupled to wrist unit adaptor 52, e.g., 20 times, and a warning showsup on the surgeon's console C. The control system then downgrades theperformance of the system by reducing the load it can deliver orincreasing apparent backlash.

Referring now to FIG. 9A, a robotic surgical system 200 including arobotic surgical manipulator 204 that is partially covered by a steriledrape 270 is shown in accordance with another embodiment of the presentinvention. FIGS. 9B and 9C are views of the robotic surgical manipulatorof FIG. 9A without the sterile drape to illustrate a multiple degree offreedom arm coupling a driving assembly with a surgical accessory clamp,a wrist unit, and a surgical tool. System 200 is similar to the systemshown and described above with respect to FIGS. 1-8 but a surgicalaccessory clamp 264 does not extend through sterile drape 270 andinterfaces with a surgical accessory 266 (e.g., a cannula) with aportion of drape 270 effectively shielding accessory clamp 264 from thesterile field of the surgery during the procedure. Advantageously,accessory clamp 264 is not required to be sterilized or replaced priorto a surgical procedure, thus allowing for cost savings, and since thereis one less opening through the sterile drape, system 200 is bettershielded from the sterile field allowing for greater insulation of thesystem equipment.

The same or similar manipulator assembly 4 including drive assembly 40,arm 42, forearm assembly 46, wrist unit adaptors 52, wrist units 22, andtools 24 (with the same or similar functionality) described above may beused within system 200 and with accessory clamp 264, and repeateddescription of the same or similar part is omitted. However, a differentdrive assembly 240, arm 242, forearm assembly 246, and interface 252 toactuate tool 224 with shaft 256 and end effectors 265 is illustrated inFIGS. 9A-9C. Embodiments of drive assembly 240, arm 242, forearmassembly 246, interface 252, and other applicable parts or tools aredescribed for example in U.S. Pat. Nos. 6,331,181, 6,491,701, and6,770,081, the full disclosures of which (including disclosuresincorporated by reference therein) are incorporated herein by referencefor all purposes. Embodiments of clamps 264, accessories 266, andportions of drape 270 will now be described in more detail.

FIG. 10 is a cross-section view of surgical accessory clamp 264,surgical accessory 266, and a sterile drape portion 270 a of steriledrape 270 therebetween, in accordance with an embodiment of the presentinvention. Surgical accessory clamp 264 includes two clamp jaws 264 athat are actuated to “capture” accessory 266 therebetween. One or bothjaws 264 a may be active or actuable. In one embodiment, a lever portionmay actuate jaws 264 a by a sliding motion or a pivot motion.

FIGS. 11A-11C illustrate an example of surgical accessory 266, such as acannula 300, in accordance with an embodiment of the present invention.Optionally, cannula 300 includes rings 302 for automatic identificationof the cannula type to surgical system 200, providing for exampleinformation verifying that the accessory is compatible with theparticular robotic system, system reconfiguration parameters if needed,and accessory-specific information such as tool-life data, cannulalength, general presence, or the like. For reading information fromrings 302, a printed circuit board (PCB) 304, a magnet 306, and sensors308 may be a part of accessory clamp 264 or forearm assembly 246 (FIGS.9B and 9C). It is noted that the present invention is not limited to acannula accessory but various accessories 266 are within the scope ofthe invention, including but not limited to reusable or disposableaccessories that can be attached or removed from the robot arm duringany time of a surgical procedure, such as endoscope/camera assembliesand surgical instruments (e.g., a retractor or a stabilizer).

FIGS. 12A-12C illustrate different views of a surgical accessory clamp400 in accordance with an embodiment of the present invention. Accessoryclamp 400 includes a base 402 for coupling to a distal end of a roboticmanipulator arm (e.g., forearm assembly 246), two clamp jaws 404, and alever portion 406 for actuating the two clamp jaws 404 into an openposition or a closed position. Different parts of accessory clamp 400are highlighted in FIGS. 12A and 12B and a cut perspective of theassembly is shown in FIG. 12C. FIGS. 13A and 13B show full assemblyillustrations with a clamped accessory.

As shown in FIG. 12A, in this particular embodiment of a clamp, a camfollower 408 runs along grooves 410 in lever portion 406 as leverportion 406 moves up and down relative to base 402 to guide the leverfor smooth operation. As the lever moves up, a second cam follower 408-1interacts with a ramped section of the lever 410-1 that activates theclamp jaws 404 between the open position and the closed position (seeFIGS. 14A-14C). The ramped section acts as a cam and a spring thatpartially determines the load applied to the accessory and the loadrequired to close the lever. In addition the cam has a high-point thatcreates an over-center feature to keep the clamp closed and givepositive feedback to the user that the clamp is engaged. Set screws 403allow for a redundant retaining method for the guide cam followers.Referring now to FIG. 12B, sensors 412 pre-assembled into a block 414are positioned by locating pins 417 within base 402 such that sensorends 412 a have fixed positions ideal for sensing identificationinformation from a clamped accessory, such as cannula 300 (FIGS.11A-11C). Screws 415 allow base 402 to be coupled to the manipulatorarm. It should be understood that various other means could be used tocouple base 402 to the manipulator arm, such as by adhesive or weldingmaterial. FIG. 12C illustrates pivot pins 420 (e.g., 8-32 threads 418)that act as the pivot axes for clamp jaws 404 as they move between theopen and closed positions. Clamp jaws 404 are biased into the openposition in this embodiment via a spring 416 between the clamp jawswhich keep the clamp jaws in the open position unless actuated into theclosed position by lever portion 406. It should be understood that theclamp could also be designed such that the clamp jaws are naturally inthe closed position unless actuated into the open position.

FIGS. 13A and 13B illustrate perspective views of assembled surgicalaccessory clamp 400 of FIGS. 12A-12C in accordance with an embodiment ofthe present invention. Cannula 300 is locked-in between clamp jaws 404which are in the closed position.

FIGS. 14A-14C illustrate perspective and side views for the positioningand clamping of cannula 300 in surgical accessory clamp 400 of FIGS.12A-12C in accordance with an embodiment of the present invention. FIG.14A shows accessory clamp 400 in a first (open) position, clamp jaws 404being biased open by spring 416 therebetween. FIG. 14B shows accessory400 positioned between clamp jaws 404. FIG. 14C shows accessory clamp400 in a second (closed) position as lever portion 406 is pushed upwardrelative to base portion 402 toward clamp jaws 404 along the directionof arrow A, thereby actuating clamp jaws 404 into the closed position.Accordingly, clamp jaws 404 are actuated by sliding lever portion 406toward clamp jaws 404. In other embodiments, a pivoting lever portionwill be shown and described below with respect to FIGS. 19-23.

FIGS. 15 and 16 illustrate different views of two examples of steriledrape portions 270 a that may fit over clamp jaws 404 of accessory clamp400 illustrated in FIGS. 12A-12C. Sterile drape portion 270 a is formedto fit to the shape of clamp jaws 404, and flexes along with the activecomponents of the clamp jaws. Thus, drape portion 270 a has a surfaceshaped (in this case cylindrical) to receive and clamp the accessory inthe closed position.

Sterile drape portion 270 a is preferably comprised of material ofsufficient rigidity and strength to allow proper placement onto thenon-sterile accessory clamp and to resist tearing even under applicationof cyclical loads in various directions, but is preferably comprised ofmaterial of sufficient flexibility to allow movement with the activesections of the clamp jaws. Sterile drape portion 270 a can be formed aspart of a single drape or a separate piece that can be attached to themain sterile drape 270 via adhesive, heat, RF welding, or other means.

FIGS. 17A-17E illustrate perspective views for positioning sterile drapeportion 270 a over clamp jaws 404 of the accessory clamp and thenclamping cannula 300 between the clamp jaws with sterile drape portion270 a between the clamp jaws and the accessory. FIG. 17A shows accessoryclamp 400 mounted at the distal end of a robot arm, such as a cannulamount section 246 a of the end of forearm assembly 246. FIG. 17B showssterile drape portion 270 a being positioned over clamp jaws 404, andFIG. 17C shows drape portion 270 a fully positioned over accessory clamp400. In one embodiment, sterile drape portion 270 a may include areinforcement 270 b that is coupled to the top surface of drape portion270 a, for example being bonded or heat staked together. Reinforcement270 b may be comprised of various durable materials, and in one exampleis comprised of high-density polyethylene (HDPE) or polyurethane.

FIG. 17D shows cannula 300 being positioned over clamp 400.Advantageously, cannula 300 may be positioned in any axial orientationdesired prior to being clamped between the clamp jaws in the closedposition. Features on the accessory may physically limit the user fromattaching the cannula incorrectly. In one example, two specific diameterclamping sections 300A and 300B are defined on the accessory forclamping. The diameters are different sizes to insure that the accessorycan not be clamped incorrectly. The larger diameter in the jaws 404 islarge enough that if the smaller diameter clamping section 300B isplaced in the area inside the jaws the accessory will not be held if thelever is closed. The smaller diameter in the jaws 404 and the limitedopen angle of the jaws make it such that the larger diameter clampingsection 300A would not physically fit in that area.

FIG. 17E shows cannula 300 fully clamped between clamp jaws 404 of clamp400, with clamp jaws 404 in the closed position as they move inward inthe direction of arrows C as lever portion 406 is moved upward in thedirection of arrow A. Cannula 300 is now rigidly and precisely attachedto the robotic arm with the sterile drape portion between the cannulaand the clamp.

Advantageously, a surgical accessory may be attached and removed from amanipulator arm during a surgical procedure without requiring the use ofan intermediate sterile accessory clamp, thus removing the need for adetachable accessory mount or adaptor that needs cleaning andsterilization and allowing for greater efficiency andcost-effectiveness. The present invention further allows for easyremoval and attachment of instruments, tools, or accessories to therobotic surgical system without breach of sterility, for exampleallowing accessory exchange with but a single hand in some instances.

FIGS. 18A-18C illustrate views of a slide accessory clamp 500 holdingcannula 300 in accordance with another embodiment of the presentinvention. A sterile drape portion between cannula 300 and clamp 500effectively shielding clamp 500 from the sterile field is not shown.Clamp 500 includes two clamp jaws 502 and a lever portion 504 thatactuates clamp jaws 502 from the open position to the closed positionvia a sliding movement. FIG. 18B shows nitronic pins 506 and leverhandle 512 of lever portion 504 that is capable of moving over-center tolock-in the accessory between clamp jaws 502. FIG. 18C shows a magnet508 and PCB with sensors 510 for sensing accessory identificationinformation from identification rings of cannula 300.

FIGS. 19A and 19B illustrate a pivot accessory clamp 600 in accordancewith another embodiment of the present invention. A sterile drapeportion between cannula 300 and clamp 600 effectively shielding clamp600 from the sterile field is not shown. Clamp 600 includes two clampjaws 602 and a lever handle 604 that is capable of moving over-center tolock-in the accessory between the clamp jaws. Clamp jaws 602 alsoinclude a detent 606 that is used to keep the lever open. Accessoryclamp 600 further includes a base 608 in which sensors and attachmentmeans may be included as described above with other embodiments.

FIG. 20 illustrates another pivot accessory clamp 700 in accordance withanother embodiment of the present invention. A sterile drape portionbetween cannula 300 and clamp 700 effectively shielding clamp 700 fromthe sterile field is not shown. Clamp 700 includes two clamp jaws 702and a lever handle 704 that is also capable of moving over-center tolock-in the accessory between the clamp jaws. In this embodiment, base708 includes a detent 706 that is used to keep the clamp jaws in theopen position, and also may include sensors and attachment means asdescribed above with other embodiments. Clamp 700 further includes asingle pivot point 710 for both clamps to move between the open andclosed positions, thereby allowing for a reduction in size of the clamp.Optionally, only one clamp needs to be opened to release the accessory.

FIGS. 21A-21B illustrate a pivot accessory clamp 800 with capturedcannula 300 in accordance with another embodiment of the presentinvention. A sterile drape portion between cannula 300 and clamp 800effectively shielding clamp 800 from the sterile field is not shown.Clamp 800 includes two clamp jaws 802 and a lever handle 804 that movesfrom an open position to a closed position to lock-in the accessorybetween the clamp jaws. A lever portion further includes pivot pins 810for pivoting the clamp jaws from an open position to a closed position.A base 808 may include attachment means for attaching clamp 800 to arobotic manipulator arm as described above with other embodiments. FIG.21B illustrates a pivot pin 812 for the pivoting of lever handle 804, acam follower 814 that rolls along the cam surface of the clamp 804, aspring plunger 816 that allows for some deflection of the cam followerwhile still transmitting force to the jaws, spring pins 818 to keep thespring plunger from coming out of the assembly, and torsion springs 822that keep the pivoting clamp jaws 802 in the normally open position andallows the jaws to close when the lever handle 804 is moved. Clamp 800further includes a sensor 820 for sensing accessory information from theaccessory.

FIGS. 22A-22C illustrate perspective views for positioning and clampingsurgical cannula 300 in surgical accessory clamp 800 of FIGS. 21A-21B inaccordance with an embodiment of the present invention. Cannula 300 ispositioned between clamps jaws in FIG. 22A. Lever handle 804 is pivoteduntil cam follower 814 clicks into a detent in FIG. 22B. Cannula 300 isthen locked-in between the clamp jaws in FIG. 22C. Advantageously, theclosed assembly may be manufactured to be no taller than the accessorysuch that the top surface of cannula 300 is flush with the top surfaceof accessory clamp 800 (i.e., a top surface of the clamp jaws).

FIGS. 23A-23C illustrate a pivot accessory clamp 900 with capturedcannula 300 in accordance with another embodiment of the presentinvention. A sterile drape portion between cannula 300 and clamp 900effectively shielding clamp 900 from the sterile field is not shown.Clamp 900 includes two clamp jaws 902, a lever handle 904, and a base908 for mounting clamp 900 to the distal end of a manipulator arm. FIGS.23B and 23C show sections of clamp 900 including a detent 906 that isused to position lever handle 904 in place between open and closedpositions. FIG. 23C shows pivot pin 910 for pivoting clamp jaws 902between open and closed positions, and a magnet 912 and PCB with sensors914 for sensing accessory information from the clamped accessory.

FIGS. 24A-24F illustrate perspective views for positioning and clampingcannula 300 in a surgical accessory clamp 1000 in accordance withanother embodiment of the present invention. Accessory clamp 1000includes a first mounting portion 1002 and a second mounting portion1004 that capture or clamp cannula 300 therebetween. A sterile drapeportion (not shown) may be positioned between first mounting portion1002 and cannula 300. In another embodiment, the clamp components (e.g.,the first mounting portion) may be part of the sterile drape andtherefore be supplied sterile and then disposed of or re-sterilized fora later use. FIGS. 24A and 24B show first mounting portion 1002 iscoupled to a distal end of a robot arm, such as forearm assembly 246,prior to or at the beginning of a surgical procedure. FIGS. 24C and 24Dshow cannula 300 being positioned over and onto first mounting portion1002. First mounting portion 1002 includes a top surface 1006 that isshaped into a “pocket” to receive a portion of cannula 300. Although inthis particular embodiment top surface 1006 is shaped into a portion ofa cylinder to mate with the surface of the cylindrical accessory, othershapes and pockets are within the scope of the present invention. FIGS.24E and 24F show second mounting portion 1004 placed over and coupled tofirst mounting portion 1002 with cannula 300 captured therebetween.

FIGS. 25A-25B illustrate perspective views of the first mounting portion1002 in accordance with an embodiment of the present invention: FIG. 25Ashows first mounting portion 1002 including retaining lips 1008 thatmate with retaining lips on second mounting portion 1004. First mountingportion 1002 further includes a tether loop 1010 for connecting tosecond mounting portion 1004 via a cable (not shown) to keep the partstogether for general ease of use. FIG. 25B shows first mounting portion1002 including a slot 1012 for attaching the retaining clip and a lip1014 for attaching the sterile drape.

FIGS. 26A-26B illustrate perspective views of the second mountingportion 1004 in accordance with an embodiment of the present invention.FIG. 26A shows second mounting portion 1004 including a tether loop 1016for connecting to tether loop 1010 of first mounting portion 1004 via acable (not shown). Second mounting portion 1004 further includesretaining lips 1018 that mate with retaining lips 1008 on first mountingportion 1002.

Embodiments described above illustrate but do not limit the invention.It should also be understood that numerous modifications and variationsare possible in accordance with the principles of the present invention.For example, although cylindrical shapes for the clamp jaws and drapeportions are described in the embodiments above, other shapes andpockets for receiving non-cylindrical shaped accessories are within thescope of the present invention. Accordingly, the scope of the inventionis defined only by the following claims.

We claim:
 1. A robotic surgical system for performing a procedure withina sterile field, comprising: a manipulator arm; and a surgical accessoryclamp for coupling a surgical accessory to a distal end portion of themanipulator arm, the accessory clamp including a base for coupling withthe distal end portion of the manipulator arm, two clamp jaws with eachof the clamp jaws directly and rotatably coupled to the base by a singlepivot pin, and a rotatably coupled lever operable to move at least oneof the clamp jaws, relative to the base, between an open position and aclosed position, and a detent structure directly coupled to the base,the detent structure contacting a single clamp jaw to keep the surgicalaccessory clamp in the open position.
 2. The robotic surgical system ofclaim 1, further comprising the surgical accessory, wherein the surgicalaccessory is a cannula defining an inner lumen for receiving a surgicaltool and providing access through a percutaneous penetration.
 3. Therobotic surgical system of claim 1, further comprising the surgicalaccessory, wherein the surgical accessory is selected from the groupconsisting of a retractor, a stabilizer, and an endoscopic camera. 4.The robotic surgical system of claim 1, wherein a portion of a steriledrape covering the accessory clamp is a vacuum formed part of a largerdrape or a separate molded portion of the larger drape and is formed tofit a shape of the two clamp jaws such that the portion of the steriledrape includes a surface shaped to receive the surgical accessorybetween the two clamp jaws.
 5. The system of claim 1, further comprisinga sterile drape covering the accessory clamp and the manipulator arm toshield the accessory clamp and the manipulator arm from the sterilefield.
 6. The robotic surgical system of claim 5, wherein the steriledrape over the accessory clamp includes a reinforcement portion.
 7. Thesystem of claim 1 wherein the two clamp jaws allow the surgicalaccessory to rotate along a length-wise axis in the open position. 8.The system of claim 1 wherein the two clamp jaws pivot about a singlepivot axis provided by the single pivot pin.
 9. The system of claim 1further comprising a printed circuit board for processing informationabout the surgical accessory received between the two clamp jaws. 10.The system of claim 9 wherein the information includes identification ofthe surgical accessory.
 11. A method of clamping a surgical accessory ina robotic surgical system, the method comprising: attaching a surgicalaccessory clamp to a distal end portion of a manipulator arm, thesurgical accessory clamp including a base for attaching to the distalend portion of the manipulator arm, two clamp jaws with each of theclamp jaws directly and rotatably coupled to the base by a single pivotpin, and a rotatably coupled lever operable to move the two clamp jaws,relative to the base to which the lever is coupled by a lever pivot pin,between an open position and a closed position, wherein attaching thesurgical accessory clamp comprises exerting a force to move at least oneof the clamp jaws from an open position kept by a detent structurecontacting a single clamp jaw to keep the surgical accessory clamp inthe open position; and attaching an accessory within the clamp jaws. 12.The method of claim 11, further comprising introducing a surgical toolthrough the accessory.
 13. The robotic surgical system of claim 5,wherein the sterile drape is comprised of material selected from thegroup consisting of HDPE, polyethylene, and polyurethane.
 14. The methodof claim 11 further comprising covering the manipulator arm andaccessory clamp with a sterile drape to shield the manipulator arm andaccessory clamp from a sterile field and attaching the accessory withinthe clamp jaws in the sterile field.
 15. The method of claim 11, furthercomprising operating the lever to keep the surgical accessory clamp inthe open position by changing a position or orientation of at least oneof the clamp jaws with respect to a detent structure coupled to thebase.
 16. A robotic surgical system for performing a procedure within asterile field, comprising: a manipulator arm; a surgical accessory clampfor coupling a surgical accessory to a distal end portion of themanipulator arm, the accessory clamp including a base for coupling withthe distal end portion of the manipulator arm, two clamp jaws with eachof the clamp jaws directly and rotatably coupled to the base by a singlepivot pin, and a lever operable to move the two clamp jaws, relative tothe base, between an open position and a closed position; and a detentstructure directly coupled to the base, the detent structure contactinga single clamp jaw to keep the surgical accessory clamp in the openposition.
 17. The robotic surgical system of claim 16, wherein the leveris coupled to the base by a lever pivot pin that.
 18. The roboticsurgical system of claim 16, wherein the lever includes an over-centerlocking feature to hold the clamp jaws in the closed position.
 19. Thesystem of claim 16, further comprising a sterile drape covering theaccessory clamp and the manipulator arm to shield the accessory clampand the manipulator arm from the sterile field.
 20. The robotic surgicalsystem of claim 16, wherein a portion of a sterile drape covers theaccessory clamp and is a part of a larger drape or a separate moldedportion of the larger drape and is formed to fit a shape of the twoclamp jaws such that the portion of the sterile drape includes a surfaceshaped to receive the surgical accessory between the two clamp jaws.